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When to Add Lateral Soft Tissue Balancing?

Hinckel, Betina B. MD, PhD*; Yanke, Adam B. MD, PhD; Lattermann, Christian MD

Sports Medicine and Arthroscopy Review: December 2019 - Volume 27 - Issue 4 - p e25–e31
doi: 10.1097/JSA.0000000000000268
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Lateral patellofemoral (PF) soft tissue abnormalities range from excessive lateral PF tightness (lateral patellar compression syndrome, lateral patellar instability and arthritis), to excessive laxity (iatrogenic lateral PF soft tissue insufficiency postlateral release). The lateral soft tissue complex is composed of the iliotibial band extension to the patella, the vastus lateralis tendon, the lateral PF ligament, lateral patellotibial ligament, and lateral patellomeniscal ligament, with intimate connections between those structures. To identify lateral retinaculum tightness or insufficiency the most important tests are the patellar glide test and patellar tilt test. Imaging aids in that evaluation relying mostly on the patella position assessed by radiographs, computed tomography, and magnetic resonance imaging with referencing to the posterior femoral condyles. Lateral retinaculum lengthening (preferred) or release may be added when there is excessive lateral retinaculum tightness. A lengthening may be performed using a minimally invasive approach without compromising the lateral patella restraint. Lateral retinaculum repair or reconstruction is indicated when there is lateral retinaculum insufficiency. Lateral retinaculum surgery to balance the medial/lateral soft tissue restraints, improves patellar positioning and clinical results.

*Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI

Brigham and Woman’s Hospital, Harvard Medical School, Boston, MA

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL

Disclosure: The authors declare no conflict of interest.

Reprints: Christian Lattermann, MD, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115.

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